HHS asks states for exchange prototypes…Five races where health reform matters…HCAN fundraiser rankles some Dems…Hospitals out against IPAB

SCOOP: HHS TO ASK STATES FOR EXCHANGE PROTOTYPES – HHS will announce today an “Early Innovators” program in which five states can get grants to fund health exchange systems with hopes that they can serve as prototypes for other states to replicate. “As we’ve been out with the states talking about 2014 and the possibility of as many states as possible doing their own exchange, they’re most concerned about the IT piece, [saying] it’s going to be expensive and it’s going to take some time,” Joel Ario, director of health insurance exchanges at OCIIO, tells PULSE. The program is designed to give states a program to build off of. States will have to apply for it and will receive grants to fund their work. Ario said the agency hasn’t yet determined how much money will be available. “We didn’t want to put a constraint on it,” he says, adding that the agency hopes for creative proposals. The POLITICO story http://politi.co/dodd1w

Good Friday Morning. Whether you expect a trick or treat on Tuesday, PULSE wishes readers a Happy Halloween. See any health-themed costumes this weekend or have one of your own? Send pictures our way: skliff@politico.com and jhaberkorn@politico.com

With four days until the election, PULSE wraps our weeklong series on elections where the health reform law matters. The final act:

FIVE RACES PULSE IS WATCHING – Six months ago, the November midterm elections were expected to hinge on the recently passed health care reform legislation, which had awoken a contingent of anti-big government conservatives. Since then, the economy and job creation has taken its place as the prime issue in midterm races across the country. Health took a backseat, but it never went away.

Health reform has played a more prominent role in some races than others. The results here could send signals for how lawmakers and 2012 candidates implement and talk about the health care law.

THERE’S ALWAYS 2012 - Democracy Corps’s Stanley B. Greenberg says the 2012 electorate will be more kind to Democrats on health reform than the people voting in the 2010 midterms. The electorate will be more non-white and younger, he told reporters during a Health Affairs briefing on Wednesday. Twenty-four percent of voters in 2008 were non-white, and it’s about 20 percent this year, he said. “African-Americans, the Latino population in particular… and young people – those are the most uninsured. Those are the biggest beneficiaries.”

--NOT SO FAST - Republican pollster Whit Ayres, president of Ayres, McHenry & Associates says the demographic changes won’t matter too much because the health law still doesn’t address the public’s chief concerns. “The fundamental problem with this bill is that the top priority of Americans is controlling … costs and premiums. They think this does exactly the opposite,” he said.

HCAN "EGOTISTICAL" - PULSE godfather Chris Frates scoops on Dem tensions over HCAN's latest fundraising drive: Health Care for America Now sent an e-mail Thursday asking supporters to give $25 or more to join an exclusive, post-election conference call with the progressive group's executive director – a move that has angered some Democrats who say it amounts to paying for access. “Please donate $25 or more to HCAN today and we'll extend an invitation for you to join our Executive Director, Ethan Rome, in a post-election strategy conference call on Friday, November 5 at 2 p.m. EST. We will discuss tactics and expectations for the next few months.” The e-mail struck some Democrats as blatant pay-to-play. “For years, Democrats have been saying money should not buy access. And now, the executive director of a progressive campaign is saying you need to pay to listen to him. This seems both egotistical and stupid,” said a Democratic health care insider. HCAN spokesman Avram Goldstein defended the e-mail, saying the criticism is “beyond absurd. ... We're extending to our supporters an opportunity to participate in a post-election discussion with our executive director. It's as simple as that.”

--NEW ADS - The pro-reform coalition is up with two billboards in downtown Seattle featuring a character from their recent Stop Spewman videos and urging drivers to vote on Tuesday. http://bit.ly/cXtQPj

PULSE EXCLUSIVE: SBA LIST DOGS DAHLKEMPER –Today in the Erie Times the anti-abortion group will run an ad that pits the freshman Democrat against the Catholic church in a conservative-leaning district. “Kathy Dahlkemper claims that anyone who says she voted for taxpayer funding of abortion in the health care bill is lying,” the ad reads. “Does she really mean to say the Catholic Church is lying?” The ad goes on to quote the United States Conference of Catholic Bishops’ statement arguing that health reform allows for taxpayer funded abortion. Ad PDF http://politi.co/aY5Dc6

NADLER WANTS PPACA LOOPHOLE FILLED—Rep. Jerrold Nadler said Thursday that he’d propose a bill to ensure that insurance companies can’t cancel entire classes of insurance coverage to deny coverage to sick policyholders unless HHS repairs what he calls a loophole in the health reform law. Nadler says Guardian Insurance Co. canceled one an entire class of policies in New York to avoid paying one of his constituents’ plans and reissued a similar plan without the provision his constituent was using. The letter to HHS http://politi.co/9UWx96

HOSPITALS AGAINST IPAB – The American Hospital Association formally came out this week in support of Sen. Cornyn’s bill to repeal reform’s Independent Payment Advisory Board (IPAB). “America’s hospitals support the repeal of IPAB because its existence permanently removes Congress from the decision-making process and threatens the long-time, open and important dialogue between hospitals and their elected officials about the needs of local hospitals and how to provide the highest quality care to their patients and communities,” they wrote in a Monday letter. Full text http://politi.co/9kVWjV

IMPARATO TO SENATE – Andrew Imparato, president and CEO of the American Association of People with Disabilities is stepping down and moving to the Senate HELP Committee as senior counsel and disability policy director for Chairman Tom Harkin. He’s also resigned his recently announced position on the PCORI board.

THE ECONOMIC DISCONNECT – A little noticed bit from this week’s NEJM poll worth noting: Republicans have done a great job connecting health reform to the economy in a way that Democrats have failed. Only 39 percent of Democrats think that the nation’s economy will be better off with health reform, compared to the 75 percent of Republicans who think it will be worse off. As POLITICO’s Ben Smith reported a few months ago, pro-reform advocacy groups have been advised to ditch the economic message and stick to the law’s new benefits. NEJM article http://politi.co/bz28mP

PolitiFact Wisconsin says Republican Reid Ribble was lying (“Pants on Fire!”) when he said he lost his health insurance and doctor because of the health reform law. Ribble is challenging Rep. Steve Kagen. http://bit.ly/cF3dDf

Join with national leaders to build consensus on the future of high-value health care delivery. Susan Dentzer, Editor-in-chief of Health Affairs, Dr. Richard Gilfillan, Acting Director of the new Center for Medicare and Medicaid Innovation (CMI) at the Centers for Medicare and Medicaid Services (CMS), and an outstanding group of panelists and moderators will be gathered to identify the next steps necessary to advance high-value health care delivery in America. The program aims to identify immediate issues to ensure the spread of high-value health care practices, formulate recommendations of innovative projects for the CMI and look to future phases of health care reform. Your experiences and ideas will help influence and form the solutions.

** A message from PhRMA: Diabetes is a complex disease affecting more than 30 million Americans – with one-in-ten living in DC, Maryland and Virginia having the disease. Thanks to advances in diabetes care, patients around the country are living longer, healthier lives. Take five-year-old Rhys for example [link to his I’m Not Average profile]. He was diagnosed with type 1 diabetes at 15-months-old, but today, he is a thriving young boy. This is due in large part to new and innovative medicines developed by researchers and scientists at America’s biopharmaceutical companies. Learn more about the medicines in development for diabetes here. **

Authors:

About The Author

Jennifer Haberkorn is a senior health care reporter for POLITICO Pro. She’s covered the Affordable Care Act since it was being debated in Congress in 2009. Since then, she has written about the law from Capitol Hill, the federal agencies, the courts and outside the Beltway.

Before arriving at POLITICO, Haberkorn covered Congress and local business news for The Washington Times. Her work has also appeared in Health Affairs and The New Republic.

Haberkorn is a graduate of Marquette University, where she majored in journalism and served as editor of The Marquette Tribune.

About The Author

Sarah Kliff is a health care reporter for POLITICO Pro. As a writer for POLITICO, she has covered how federal regulation, Congress and lobbying affect the implementation of health care reform. She previously co-authored Pulse, a daily health policy briefing.

Prior to joining POLITICO, Kliff was a staff writer at Newsweek, where she covered issues at the intersection of health and politics. She also covered the 2008 election, traveling with Joe Biden and contributing reports to multiple Newsweek cover stories. She has also written for National Geographic, St. Louis Magazine and Humanities magazine.

Kliff attended Washington University in St. Louis, where she was editor-in-chief of the campus newspaper, Student Life. She grew up in Seattle and Toronto, cities that have left her a big fan of the Toronto Maple Leafs and coffee.